Why Brain Injury is Actually a Chronic Disease

You never expect these things to happen in life. But last year, three days before Christmas, I experienced a traumatic brain injury. As a practicing Functional Medicine doctor who has been in the field for more than 20 years, I love what I do and take great care of my health. I never expected something like this, so sudden and disruptive, to happen to me.

It’s hard to believe what seemed like such a minimal incident turned into something so big. I was at CrossFit with my wife and while doing a pull-up, I hit my head on a bar that I didn’t see above me. Of course, I didn’t think much of it, because I’ve hit my head a lot worse in life. About 20 minutes later though, in the workout, I suddenly had the worst headache of my life. It was like someone took an ax and buried it in my head. I got nauseous and dizzy and just fell overall pretty awful. My wife took me home and the headache seemed to dissipate.

As the day went on, it got worse, and then it got better again. Several days went by, and finally, I ended up in the emergency room on Christmas Eve. The headache was just so bad I couldn’t imagine doing one more thing without getting some relief. In the ER, they did a CAT scan and found that I had a subarachnoid hemorrhage, which is basically a bleed in the middle of my brain. Like I said before, it’s incredible that what seemed like a small bump on the head turned out to be something so dangerous.

I ended up in a neurointensive care unit in Boston for three days. If you’ve ever been in one, it’s like an oxymoron, because they wake you up every hour to make sure that you’re not going into a coma. So, you can’t sleep, you can’t concentrate, you’ve got tubes and wires all over you. I just recently told my wife, “One of the best days of my life was when you took me out of the intensive care unit.” When we left, I was just told to, “Go home and rest.” That was it!

I went home with pain medication for my headaches. Very shortly after I got home, I realized that my life had changed dramatically. After the headaches started to dissipate, I really noticed that I was disconnected. I was feeling emotionally flat, isolated. I noticed that I had a lot of mental and physical fatigue. My sleep was disrupted, so I couldn’t sleep. I couldn’t focus. I couldn’t concentrate. I had a hard time remembering things. It’s not like I forgot things altogether, I just had a hard time finding them in my brain. Every day, I felt like my brain was on fire. I could actually feel my brain and it all seemed to just get worse over time.

I’ve had injuries before, and I’ve used my mind to get my body to do what I want it to do. In the past, I’ve been able to overcome significant injuries pretty well. I’ve even been able to feel better than I was before the injury. Your brain and mind can push your body, but when your mind isn’t working, you can’t do anything about it.

I was really worried that I wouldn’t get my memory back—that my focus, attention, and my ability to learn new material, wouldn’t return. That was really scary.

Another scary piece was feeling extremely disconnected. My wife and I have been together for 39 years. She’s my soulmate. When I’m laying in bed next to her and I’m feeling absent, and not connected, that’s a terrible feeling. I think that’s where I learned a lot. I had two sons who played soccer, and they both had very significant concussions and brain injuries, and I’d done a lot of research about concussions to help them get better. So when I had my own brain injury, I continued to do some reading to learn what else I could do to heal. Over time, I was able to support my body in multiple ways and fully recover to once again feel my best.

What I really began to understand in my research, and I think many people don’t get, is that traumatic brain injury doesn’t just come and go. It’s actually a chronic disease, and depending on how you’re wired—depending on your genetics, your lifestyle, and any other diseases you may have developed—your brain may not recover, or the neuroinflammation may persist.

On a larger scale, right after a traumatic brain injury, I personally think the two areas that are most important and most impacted by neuroinflammation are the basal ganglia and the hippocampus. The basal ganglia is comprised of a group of structures that connects the cortex to the brain stem; this area is responsible for coordinating focus, learning, concentration, higher-level reasoning, coordination, motor activity, and mood regulation. If the basal ganglia’s been impacted, you’re going to struggle with all those areas.

The hippocampus, on the other hand, is involved in memory and recognition. Making new memories, maintaining memories, and recognizing things. Neuroinflammation really impacts those things—when you can’t recognize, and your memory isn’t working, and your day-to-day activities are impacted by the fact that you can’t focus, concentrate, reason, or control your mood or your motor activities, you feel like you will never be productive again.

Now, inflammation is good. When you get injured, particularly in a brain injury, you’re going to have an inflammatory response that begins the healing process. You have these proinflammatory cytokines and anti-inflammatory cytokines that are working together to help your brain heal. But if those inflammatory processes and coinciding immune processes continue, they can lead to more inflammation and more damage over time. That’s where that chronic degeneration of the brain over months and years can occur.

If you haven’t dealt with those issues, if you haven’t done anything to turn that inflammation off, then you might find that those issues that you’re having early-on with memory, mood, physical coordination, and learning just get worse. Neuroinflammation needs to be turned off; if that doesn’t happen, or if there’s anything else that’s promoting inflammation, you’re in trouble.

Recently, they have found that there’s actually a lymphatic system in the brain, called the glymphatic system. Previously, the brain wasn’t thought to have its own lymph system. The glymphatic system actually is connected to the peripheral lymph system, which is a direct connection to your immune system. That means if you have leaky gut, you’re going to have leaky brain.

So think of it like this: You’ve just had trauma to your brain, your blood-brain barrier’s been damaged, and the soft tissues of your brain have been damaged too. You already have an inflammatory process going on in your gut (as many Americans do)–which is now linked to your brain through the lymph system. That inflammation and any autoimmunity that is occurring in your gut could potentially lead to more inflammation and autoimmunity in your brain.

Plus, your immune system can start to make antibodies against that damaged brain tissue. Now you have neuroinflammation, an immune response that could be leading to ongoing damage to tissues in your brain that had nothing to do with the original impact, or in my case, bleed.

The really good news is that there is so much you can do to reverse the damage of a traumatic brain injury and reduce neuroinflammation. One thing within reach for all of us is sleep. The glymphatic system, that detoxification pathway I mentioned earlier, is actually at its most active state when we sleep. That gives the brain a chance to clean out all the neurological waste and distribute beneficial nutrients around.

Sleep also increases brain-derived neurotrophic factor (BDNF), a protein that supports our existing brain cells and helps create new ones. Exercise is also a great way to increase BDNF. And guess what? Sleep and exercise both also boost your mitochondria, the cellular powerhouses responsible for producing energy from food. Supporting BDNF and mitochondria are two major pieces when it comes to healing from a traumatic brain injury, and sleep and exercise are two lifestyle factors all of us can prioritize on our healing journey.

It’s also important to eat a nutrient-dense diet rich in antioxidants and healthy fats to support brain healing, while avoiding any foods that lead to inflammation, like refined sugars, gluten, and vegetable oils among others. Choose organic and grass-fed or pasture-raised foods when possible to avoid exposing your body to toxic chemicals and hormones that can also lead to immune dysfunction and inflammation.

These are just some of many different interventions you can take to support the brain, whether you’ve had an injury or not. I hope my story has helped you understand why traumatic brain injuries really are a chronic disease, but that there is hope to heal and fully recover.